JUSTICE/DISTRICT COURT OF ____________________ COUNTY/CITY _____________ JUDICIAL DISTRICT ADDRESS: _______________________________________________ ______________________________________________, Plaintiff VS. _____________________________________________, Defendant AND _____________________________________________, Defendant JUDGMENT INFORMATION SHEET (FORM N) Case No _____________________ 1. The [Plaintiff] [Defendant] in this action, as judgment creditor, provides the following information in compliance with Section 78-22-1.5. 2. The correct name of the judgment debtor is __________________________________. 3. The correct last known address of the judgment debtor is _________________________ __________________________________________________________________________. 4. The address at which the judgment debtor received service of process is ____________ __________________________________________________________________________. 5. a. b. c. The judgment debtor is [not] a natural person [and] the social security number of the judgment debtor is ______________________, the date of birth of the judgment debtor is ______________________________, and the driver’s license number of the judgment debtor is _____________________. 6. The name of the judgment creditor is ________________________________________. 7. The address of the judgment creditor is _______________________________________ __________________________________________________________________________. 8. The amount of the judgment is $_____________________. The judgment has not been satisfied. 9. [The judgment has not been stayed.] [The judgment has been stayed, and the stay expires on _______________________________.] 10. This judgment information statement was recorded in the office of the recorder of ____________________ county on __________________. 11. The county recorder’s entry number is _________________. 12. The judgment creditor has reviewed its own records, the records of its attorney and the records of the court in which the judgment was entered. Any information required by Section 7822-1.5 but not provided in this statement is unknown and unavailable. American LegalNet, Inc. www.FormsWorkflow.com _______________________________________ [Attorney for] Judgment Creditor Party Name: _____________________ Party Address: ___________________ _______________________________ American LegalNet, Inc. www.FormsWorkflow.com